SAFE aims to improve the diagnosis of deep infiltrating endometriosis by TVUS through education and
workshops.

SAFE also provides information where expert ultrasound
assessments for endometriosis are currently available.

About SAFE

SAFE consists of a team of gynaecologists who specialised in
ultrasound. The organisation strives to improve the transvaginal
ultrasound
diagnosis of deep infiltrating endometriosis through education and
workshops for all imaging specialists.

Endometriosis is a common condition affecting 15% of women in the
reproductive age group. Because period pain is common and
endometriosis requires surgery for definitive diagnosis, the
diagnosis and treatment of the disease is often delayed. Not
uncommonly patients are told their symptoms are normal, leading to
significant frustration when the disease is finally diagnosed often
years later.

The ability to diagnose deep infiltrating endometriosis with
transvaginal ultrasound has improved dramatically around the world
since 2009. A number of Australian sonologists and
sonographers have developed an expertise in this area through
overseas training. Because ultrasound is a non invasive technique,
the barrier for women with symptoms of endometriosis to undergo the
test is lower. Unfortunately not all forms of endometriosis can be
detected on ultrasound, but deep infiltrating endometriosis, which
is the hardest one to treat, can be diagnosed with a high degree of
accuracy.
The preoperative diagnosis leads to better outcomes for
patients through better preoperative preparation and counselling.

Every woman referred for ultrasound
because of pain or infertility should have access to an expert
gynaecological ultrasound which should include a thorough assessment
for endometriosis. The ultrasound practices where an endometriosis
assessment can currently be performed are listed on this website.
The aim of the organisation is to make the list longer each year
until it is redundant because the assessment is available
everywhere.

Endometriosis

Endometriosis is the presence of lining of the uterus
(known as endometrium), outside the uterus. Endometriosis
occurs because some blood flows back through the Fallopian tubes into
the pelvis during a period. Approximately 15% of women will allow
those endometrial cells to implant in the pelvis. These endometrial
cells behave like the cells in the real lining of the uterus and
respond to hormones causing pain during periods. Most of the time
these cell implants are just superficial deposits. About 20% of
women however will not just allow those lining cells to implant, but
also to infiltrate mainly into bowel, bladder and ligaments behind
the uterus (uterosacral ligaments). This form of the disease
is called deep infiltrating endometriosis (DIE). The treatment of
DIE is significantly more difficult. DIE can be diagnosed with
transvaginal ultrasound with a high degree of accuracy.

Ultrasound for deep infitrating endometriois

The ultrasound for endometriosis is a normal vaginal ultrasound.
Rather than just examining the uterus and the ovaries, the
examination is extended to include structures that are often
affected by deep infiltrating endometriosis such as the ligaments
behind the uterus (uterosacral ligaments), the bladder, the bowel
and the pouch a Douglas. With increasing expertise this does not
take much longer than a regular transvaginal ultrasound.